Interactional Compression and Maternal Participation in Neonatal Intensive Care Units: A Qualitative Study of
Nadia Bassuoni Elsharkawy1, Osama Mohamed Elsayed Ramadan1, Alaa Hussain Hafiz2
1Department of Maternal and Child Health Nursing, College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia.
Background/Objectives: Nurse-mother communication is central to maternal participation in Neonatal Intensive Care Units (NICUs), yet high acuity and workflow rhythms can compress dialogue and weaken shared understanding. This study used Communication Accommodation Theory and the Transactional Model of Stress and Coping to explain multilevel drivers of communication barriers and to co-produce feasible improvement strategies. Methods: A dyadic qualitative design was conducted across four Level III NICUs. Data were triangulated from 37 semi-structured interviews (18 mothers and 19 nurses, recruited through purposive maximum-variation sampling), approximately 40 h of non-participant observation, and 12-unit documents. A team-based codebook thematic analysis was applied, integrating observational logs with interview and document data to refine patterns and mechanisms. Results: A context-produced pattern of interactional compression was identified. Mothers contributed 2 or fewer speaking turns in 21/30 logged bedside encounters and were present in 13/16 observed round episodes, speaking in 5/13 of those episodes. Interpretability and language access gaps were common: unexplained technical terms occurred in 24/46 logged interactions; teach-back prompts occurred in 7/18 education encounters; professional interpreters were present in 3/9 language-discordant events. Three participation configurations described coping-linked engagement: threat-compression (n = 8), convergence-to-coping (n = 6), and resource-scaffolded participation (n = 4). In co-production, stakeholders co-produced (i.e., collaboratively identified and prioritized) three mechanism-targeted changes: protected post-round question-and-answer time incorporating teach-back, standardized visual "mini-packs," and 24/7 interpreter access. Conclusions: Nurse-mother communication in NICUs can be structurally compressed by workload rhythms and uneven interpretability supports. Co-produced organizational scaffolds may expand opportunities for accommodation, comprehension verification, and equitable maternal participation.
Background/Objectives: Nurse-mother communication is central to maternal participation in Neonatal Intensive Care Units (NICUs), yet high acuity and workflow rhythms can compress dialogue and weaken shared understanding. This study used Communication Accommodation Theory and the Transactional Model of Stress and Coping to explain multilevel drivers of communication barriers and to co-produce feasible improvement strategies. Methods: A dyadic qualitative design was conducted across four Level III NICUs. Data were triangulated from 37 semi-structured interviews (18 mothers and 19 nurses, recruited through purposive maximum-variation sampling), approximately 40 h of non-participant observation, and 12-unit documents. A team-based codebook thematic analysis was applied, integrating observational logs with interview and document data to refine patterns and mechanisms. Results: A context-produced pattern of interactional compression was identified. Mothers contributed 2 or fewer speaking turns in 21/30 logged bedside encounters and were present in 13/16 observed round episodes, speaking in 5/13 of those episodes. Interpretability and language access gaps were common: unexplained technical terms occurred in 24/46 logged interactions; teach-back prompts occurred in 7/18 education encounters; professional interpreters were present in 3/9 language-discordant events. Three participation configurations described coping-linked engagement: threat-compression (n = 8), convergence-to-coping (n = 6), and resource-scaffolded participation (n = 4). In co-production, stakeholders co-produced (i.e., collaboratively identified and prioritized) three mechanism-targeted changes: protected post-round question-and-answer time incorporating teach-back, standardized visual "mini-packs," and 24/7 interpreter access. Conclusions: Nurse-mother communication in NICUs can be structurally compressed by workload rhythms and uneven interpretability supports. Co-produced organizational scaffolds may expand opportunities for accommodation, comprehension verification, and equitable maternal participation.
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